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  • Title: Operative versus conservative management for 'fetal distress' in labour.
    Author: Hofmeyr GJ, Kulier R.
    Journal: Cochrane Database Syst Rev; 2000; (2):CD001065. PubMed ID: 10796236.
    Abstract:
    BACKGROUND: Suspected fetal distress usually results in expedited delivery of a baby (often operatively). The potential harm to a mother and baby from operative delivery may not always be justified especially when fetal distress may be misdiagnosed. Even with a correct diagnosis it is not clear whether an operative or conservative approach is better. OBJECTIVES: The objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1997. SELECTION CRITERIA: Randomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by both reviewers. MAIN RESULTS: One study of 350 women was included. This trial was carried out in 1959. There was no difference in perinatal mortality (relative risk 1.18, 95% confidence interval 0.56 to 2.48). REVIEWER'S CONCLUSIONS: There have been no contemporary trials of operative versus conservative management of suspected fetal distress. In settings without modern obstetric facilities, a policy of operative delivery in the event of meconium-stained liquor or fetal heart rate changes has not been shown to reduce perinatal mortality.
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